Diaphragmatic hernia - traumatic

Case contributed by Dr Lemuel Marquez Narcise

Presentation

Patient thrown off a motorcycle then hit the ground. Complaining of difficulty breathing.

Patient Data

Age: 55 years
Gender: Male

Diaphragmatic hernia

X-ray

Bowel loops are seen at the left hemithorax.  The mediastinal structures are shifted to the right.

Diaphragmatic hernia

CT

The stomach, portions of the small and large bowels, and large amount of mesentery are seen herniated through the left hemithorax.  These compress and displace the left lung parenchyma.  The heart and the rest of the mediastinum is shifted to the right.  There is no evidence of pneumothorax on the left.

Case Discussion

Traumatic herniation of abdominal contents through a tear or rupture of the central or posterior aspect of the hemidiaphragm may follow blunt thoracoabdominal trauma.  The left side is more commonly affected. The diagnosis should be suspected when the left hemidiaphragmatic contour is indistinct or when gas-filled stomach or bowel loops are seen in the left hemithorax following trauma.

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